Hawai Finance

Jan 20 2018

Palliative chemotherapy – a term that should be laid to rest, GeriPal – Geriatrics and

palliative chemotherapy

Palliative chemotherapy

” Palliative chemotherapy is defined as treatment in circumstances where the impact of intervention is insufficient to result in major survival advantage, but does affect improvement in terms of tumor-related symptoms, and where the palliation/toxicity trade-off from treatment clearly favors symptom relief.”

Palliative chemotherapy


I agree that Palliative chemo is term that should not be used. The question is how. No one owns the word. It is already in fairly wide use. It s going to be a long, uphill struggle to remove the phrase for oncology conversations.

I defy you to name one treatment intervention that is not palliative, other than antibiotics for acute infection, and perhaps certain surgical conditions such as cholecystitis or appendicitis, all acute nonetheless. Why don t we call it palliative bypass surgery when a revascularization procedure is performed for ischemic heart disease? It fits the definition of palliative; to relieve without curing. Help me with my thinking on this. Isn t almost every medical intervention directed at remittive therapy and amelioration of the effects of some chronic condition resulting in disordered biology? I for one, am no longer a palliative care doctor! I have changed my specialty designation to patient centered care specialist . Let s just scrap the term palliative altogether, because it s all palliative, baybee!

We shouldn t use the term palliative chemotherapy. Instead we should say specifically what the chemotherapy is used for: chemotherapy for symptom relief, chemotherapy to prolong life, or chemotherapy to cure.

sir, the answer to ypur query is in your words itself.

provide symptom relief and improve the quality of life, what else is palliative care?

In Rheumatology, they have treatment called DMARDs, disease-modifying anti-rheumatological drugs. (say: d-mard.) I call chemo and radiation disease-modifying therapies. You could use an acronym, Disease-modifying anti-neoplasm drugs: DMAND. (say: d-mand.) but it s faster just to say disease-modifying therapies .

In Rheumatology, they have treatment called DMARDs, disease-modifying anti-rheumatological drugs. (say: d-mard.) I call chemo and radiation disease-modifying therapies. You could use an acronym, Disease-modifying anti-neoplasm drugs: DMAND. (say: d-mand.) but it s faster just to say disease-modifying therapies .

Palliative chemotherapy

Palliative implies that the patient feels better. So for example, preventative care by definition is not palliative. Mammograms, Dexa s, colonoscopies are not palliative.

Disease modifying therapies are often not palliative such as tight vs loose control of Dm2, Htn, hyperlipidemia. No one has ever felt bad for having an LDL of 190. Treatment of asymptomatic CAD is not palliative either. To put it in simple terms, it s hard to make a patient who feels fine, feel even better. In that sense, dialysis is not often a palliative intervention. People trade QOL for longevity.

Often times the treatment is called Palliative Chemo so that Hospice will consider paying for it.

Palliative chemotherapy

In my experience palliative chemo is non curative. I think it should be renamed life prolonging chemo

Dianne Stockwell RN CHPCA(c)

Palliative chemotherapy

Palliative is an adjective that should be used only to describe the actual outcome achieved of an intervention. This will allow decision making between patients and physicians to be honest. No switch and bait. No euphemisms. No categorization based on intent or wishful thinking or theoretical design or animal models or financial structures or emotional purpose.

1. Curative chemo (I suppose divided into really effective curative chemo and there s a chance curative chemo)

2. Non curative/life prolonging chemo

3. Non curative/life shortening/useless chemo

4. Palliative chemo

Palliative chemotherapy

Get this. I have Stage IV, Nasopharengeal carcinoma widespread to the bone. I ve had one round of chemotherapy (6 treatments), neck surgery (40 lymph nodes removed), and because of headaches, vomiting, hearing impairment, sore teeth, and fatigue, I was given a choice of palliative radiiation (4,000 Gy s), or go for a permanet cure (7,000 Gy s). Yes! a permanent cure, was the language used by the oncologist if I chose the 7,000 Gy s. well, I chose the palliative radiation dose, as i know there is no cure for me. He was not the only oncologist who used the word cure in his discussions with me. I feel disrespected and nearly pushed into greater toxins and side effects that I do not need. The symptoms have gone away (4,000 worked for now), and my quality of life is at an all time high — living with cancer I have discovered is much better than spending all my time fighting it (with extreme side effects as a resullt — the result is not quality, but rather quantity (a very small quantity). Who in the world is training oncologists?

David B. Oliver, PhD

Thank you, Dr. Uy for the shout-out to surgeons. The term palliative care was first introduced by a surgeon (Mount). As a surgical oncologist, I am THRILLED to see other like-minded palliative care providers interested in taking back our name and not branding treatments as palliative when they are, in fact, not directed or intended toward symptom improvement or improved quality of life. While one might argue that living longer is a quality of life outcome, I think many of us know that longer is not always better. I wholeheartedly encourage using more precise language so patients, families, and providers are clear about the intent of our interventions–be if chemo, surgical resection of a tumor, re-vascularization procedures. So, where do we go from here? How do we get this message out?

Palliative chemotherapy

Thanks to all for the comments here. A few responses:

Palliative chemotherapy

I have another complaint about the word palliative chemo. I was asked as medical director of a hospice to approve palliative chemo for a young woman with uterine cancer. The oncologist called it agressive and life prolonging as did the patient. The referring doctor called it palliative so hospice would take the patient and pay for the chemo as he was the medical director of the HMO that was at risk. I declined so he went to another hospice.

Palliative chemotherapy

There is obviously a huge amount of confusion abou how to define palliative, even in THIS community! Palliative comes from the word to cover over. Something palliative therefore makes symptoms better WITHOUT fixing the underlying problem. So, if you accept that definition, disease-modifying treatments are not palliative, even if they help someone feel better. So an appendectomy and antibiotics are NOT palliative, since they alter the underlying course.

If you define palliative as simply feeling better as some above do, then almost any effective chemotherapy IS palliative, since the best way to get rid of cancer symptoms is to shrink the cancer! By the more traditional definition, almost NO chemotherapy is palliative.

So while antibiotics, chemo, and disease-oriented treatments are not palliative, treating a cold, low back pain, and any therapies for pain or symptom relief are palliative. Procedures that relieve local cancer symptoms such as stents and some radiation could be considered palliative.

Finally, remember that just because something is not palliative doesn t mean it is bad. I think almost everyone would prefer an effective well-tolerated disease-modifying or curative treatment to a purely palliative one. However, I strongly agree that the term palliative chemotherapy is incorrect and misleading and should not be used (though palliative radiotherapy is usually fine!) Now how to convince the oncologists.

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